Active NPI
Jesse Elledge, DDS
- Dentist
- Columbia Falls, MT
National Provider Identifier
1285100776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 19915
- Practice address
- 105 Nucleus Ave
Columbia Falls, MT 59912-4010 - Phone
- (530) 446-4714
- NPI assigned
- Oct 23, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 19915 | MT | Primary |
Addresses
Primary practice location
105 Nucleus Ave
Columbia Falls, MT 59912-4010
Mailing address
PO Box 1866
Columbia Falls, MT 59912-1866
Phone (406) 892-2104
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19915 | MT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Smile Montana Dental Group PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Columbia Falls, MT
- NPI 1457156374
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632441600000",
"number": "1285100776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1866",
"city": "COLUMBIA FALLS",
"state": "MT",
"postal_code": "599121866",
"telephone_number": "406-892-2104",
"fax_number": "406-892-1422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 NUCLEUS AVE",
"city": "COLUMBIA FALLS",
"state": "MT",
"postal_code": "599124010",
"telephone_number": "530-446-4714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLEDGE",
"first_name": "JESSE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-10-23",
"last_updated": "2021-09-24",
"certification_date": "2021-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MT",
"license": "19915",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia Falls, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.